Perhaps you are designing a clinical trial or creating demographics for developing a survey. The cardinal rule whispered throughout your enterprise--garbage in, garbage out reminds you to ask better questions.

Questions that will most likely be interpreted the same by respondents or as close to "same" as we can muster are carefully developed. You have reviewed research methodology to understand the constructs of how we ask questions and what types of questions are the best design for gathering rigorous and actionable data.

You have even updated your tools to include robust racial demographics. But why? Are you looking for biologic differences or the impact of social determinants? I never rely on race but map to social constructs, genetic variants (identified within disease states), and geographic trends.

"Any two individuals within any so-called race may be as different from each other as they are from any individual in another so-called race."--Race-The Power of an Illusion

For context, the US Census describes the following race categories:

White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who indicate their race as "White" or report entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or Caucasian.

Black or African American. A person having origins in any of the Black racial groups of Africa. It includes people who indicate their race as "Black, African Am., or Negro"; or report entries such as African American, Kenyan, Nigerian, or Haitian.

American Indian and Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. This category includes people who indicate their race as "American Indian or Alaska Native" or report entries such as Navajo, Blackfeet, Inupiat, Yup'ik, or Central American Indian groups or South American Indian groups.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. It includes people who indicate their race as "Asian Indian," "Chinese," "Filipino," "Korean," "Japanese," "Vietnamese," and "Other Asian" or provide other detailed Asian responses.

Native Hawaiian and Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. It includes people who indicate their race as "Native Hawaiian," "Guamanian or Chamorro," "Samoan," and "Other Pacific Islander" or provide other detailed Pacific Islander responses.

Two or more races.

In 2020 (the next census) suggested changes include combining race and ethnicity questions regarding Hispanic identity and adding a Middle-East-North Africa category.

If you work with data you might already have an awareness that biologic differentiation would relate to geography--not race specifically. We roll up a lot of information into a single check box.

​If we want to know about lung capacity, drug metabolism, or diet, why don't we just ask the questions rather than think a check box can tell us anything about the populations we study?

The racialized society we live in has been under construction for three centuries. How can we unmake race unless we first confront its enormity as a historical and social reality, and its emptiness as biology?--Race-The Power of an Illusion

The present work examines beliefs associated with racial bias in
pain management, a critical health care domain with well-documented
racial disparities. Specifically, this work reveals that a
substantial number of white laypeople and medical students and
residents hold false beliefs about biological differences between
blacks and whites and demonstrates that these beliefs predict
racial bias in pain perception and treatment recommendation
accuracy.

​ It also provides the first evidence that racial bias in pain
perception is associated with racial bias in pain treatment recommendations.
Taken together, this work provides evidence that
false beliefs about biological differences between blacks and
whites continue to shape the way we perceive and treat black
people—they are associated with racial disparities in pain assessment
and treatment recommendations.--

When designing surveys do not take short-cuts. It doesn't make sense to use the "proxy" of race for the questions we aren't asking--dig deeper in defining demography--let science and perhaps even history be your guide.

Well, doctors tell me they're using race as a shortcut. It's a crude but convenient proxy for more important factors, like muscle mass, enzyme level, genetic traits, they just don't have time to look for. But race is a bad proxy. In many cases, race adds no relevant information at all. It's just a distraction.

​Race medicine also leaves patients of color especially vulnerable to harmful biases and stereotypes. And if you find race-specific medicine surprising, wait till you learn that many doctors in the United States still use an updated version of a diagnostic tool that was developed by a physician during the slavery era, a diagnostic tool that is tightly linked to justifications for slavery.

Dorothy Roberts. Professor of Africana studies and law and sociology at the University of Pennsylvania.

​When designing surveys I suggest embedding information such as World Region of Birth of Foreign Born, Ancestry, or other data available from the 2010 Census, American Community Survey, or American Housing Survey.

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